Home Health & Hospice Week

Do you know when to count episodes as 'early' or 'late' after patients' Medicare Advantage enrollment ends? You could be subject to reimbursement take-backs or worse -- fraud and abuse charges -- if you don't know the ropes when billing for patients coming out of Medicare Advantage. Under the prospective payment system refinements that took place in 2008, Medicare pays more for a "later" (third or later) episode than an"early" (first or second) episode. The question: Many home health agencies don't know whether to count Medicare Advantage episodes when determining early or later status in M0110, industry experts say. The answer: "Episodes covered by Medicare Advantage plans are not considered in determining adjacent episodes," regional home health intermediary Palmetto GBA reminds HHAs in a question-and-answer set from its latest Ask The Contractor meeting. Another tip: Episodes denied by Medicare also do not count when determining early or later episode status, the Centers for [...]